Due to the continued escalation of medical care costs, growth of managed health care, and the health care reform movement in general, there is increased pressure on health care service providers to establish cost containment programs. Unfortunately, there is no currently available medical diagnostic apparatus or methodology, which allows for objective quantification of an individual's orthopaedic movement function and/or physical therapy dysfunction, as it relates to various body regions, including cervical spine, thoracic spine, lumbar spine, shoulder, elbow, wrist, hip, knee, ankle, and foot. There is also no available mechanism that is capable of quantifying the severity of dysfunction of the various body regions of a patient as a result of a physical therapy initial evaluation; nor is there any routine available that allows for the objective measurement of the patient management process to include progression, improvement, and objective measurement of the efficiency of the overall physical therapy services (patient improvement divided by the number of treatment visits and cost).
Further, there is no mechanism by which physical therapy intervention and treatment outcomes can be objectively measured and numerically classified, so as to allow for comparative analysis regarding discharge, percent improvement, number of visits, and efficiency. There is also no procedure which objectively and numerically charts a patient's management process to include progress and improvement plateau, oscillation, or decline. There is no available scheme which provides for comparative data of a patient's initial evaluation, discharge, improvement, treatment visit number, and efficiency based upon body region or specific ICD-9-CM codes. (The commonly used notation "ICD-9-CM" corresponds to the International Classification of Diseases, 9th Revision, Clinical Modification, and refers to a coding system based upon and compatible with the original version of the ICD-9 coding system provided by the World Health Organization. The ICD-9-CM coding system is used in North America, and it is a classification of diseases, injuries, impairments, symptom, medical procedures, and causes of death, These codes are listed in detail in a publication of the Commission on Professional and Hospital Activities, Ann Arbor, Mich., entitled "ICD-9-CM," Jan. 1, 1979.)
There is also no method available which allows for comparisons between different physical therapist efficiencies and improvements of specific ICD-9 codes, body region, and overall treatment results of a general physical therapy patient, or which allows for objective measurement and comparisons of physical therapy corporations, efficiency of physical therapy services, and results obtained from specific body regions, or specific ICD-9 codes. In fact, there is no objective outcome measurement tool which utilizes physical therapy documentation.
This inability of the treating health care service provider to quantify the extent of dysfunction and recovery therefrom causes uncertainty in the treatment protocol, as well as the psychological uneasiness in the patient being treated. This inability to quantify dysfunction has also unfortunately frequently been the source of fraudulent medical claims against insurance carriers and patients, resulting in arbitrary fee and reimbursement capitations and treatment visit restrictions, which are only implemented from a financial perspective and have no bearing upon the patient status.
Such inability of conventional therapy procedures to quantify patient dysfunction has also resulted in a lack of cooperation and collaboration among health care service providers as to what treatment protocols are the most effective and efficient, and therefore has hindered the growth and expanse of medical knowledge.
Although there have been various attempts to provide quantitative measures of the severity of a patient's dysfunction, such prior methods have focused upon a specific body area and diagnosis, most notably the lumbar spine or knee, and are also dependent upon a specific treatment intervention. The outcome measures are not comparative with other providers or to other patient population with the same diagnosis.
Other methodologies require specialized certification or an MD degree and costly equipment, impairment ratings, or functional capacity assessments. These also have no correlation with the initial physical therapy evaluation, subsequent treatment intervention, and patient improvement. None provide for comparative statistics for diagnosis, body region, therapist, and corporation; and none pertain to the routine physical therapy evaluation, treatment and discharge, or patient management process. Still others have attempted to draw conclusions from data correlated and derived from the application of subjective patient reported pain ratings and patient satisfaction questionnaires.